CARE HOMES FOR OLDER PEOPLE
St Bridget`s Residential Home 42 Stirling Road Talbot Woods Bournemouth Dorset BH3 7JH Lead Inspector
Debra Jones Unannounced Inspection 14th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Bridget`s Residential Home Address 42 Stirling Road Talbot Woods Bournemouth Dorset BH3 7JH 01202 515969 01202 291347 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Anthony Howell Mrs Denise Simpson Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th April 2005 Brief Description of the Service: St Bridget’s Residential Home has the capacity to care for fourteen older people but in practice has no more than ten people living there, all enjoying single rooms. The home is set in a large 1930s converted house, in a quiet residential area of Bournemouth – Talbot Park – close to shops and other local amenities. The home is over two floors – ground and first – and there is a passenger lift. There are a variety of aids around the building to allow residents to move about more independently. All 10 rooms are currently used as single rooms. One of them has an ensuite. There are four communal toilets and two baths – the more popular one has a mechanical bath seat. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 2 hours and was the second of the two anticipated inspections of the year. The 5 recommendations and 8 requirements made at the last inspection were followed up with the manager to see if the home had made any progress towards meeting them. The Inspector looked around some of the building and a number of records were inspected. All residents spoken with expressed satisfaction with the home. What the service does well: What has improved since the last inspection?
Now after someone from the home has carried out a pre admission assessment the home confirms in writing that the home is able to meet the potential residents’ needs to give them the necessary reassurance that the home is right for them. Significant progress has been made by the home to improve their medication handling systems to ensure that residents have the medication when they need it and that it is always clear how much medicine is and should be in the home. The adult protection policy has been reviewed demonstrating the home’s commitment to providing a safe environment for residents that is free from abuse. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 6 An audit has been undertaken in respect of the health and safety needs of individuals living at the home. As a result of this one call bell lead was extended to ensure that the resident was always in a position to contact staff in the event of an emergency wherever they were sitting or lying in their room. The manager has made sure that every member of staff has had their fire training when it was due. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 (Standards 1,3 and 5 were met at the last inspection). Following needs assessments carried out by the home, St Bridget’s now has a letter they can send that will assure prospective residents that their needs can be met at the home. EVIDENCE: A standard letter has been written that will be sent to prospective residents who have been assessed as suitable to live at the home confirming that, following the pre admission assessment, the home considers themselves able to meet their needs. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 (Standards 7 8 and 10 were met at the last inspection.) Significant progress has been made in ensuring that medication at the home is well managed in order to promote the good health and well being of residents. EVIDENCE: In April 2005 the home was visited by the Commission’s pharmacy Inspector. Following this visit a number of requirements and recommendations were made which were followed up at this general inspection. The home has now revised and expanded their medication policy as advised. The arrangements for security of keys to medicines cupboards in residents’ rooms has been reviewed. A thermometer to monitor and record daily the maximum and minimum temperatures of the refrigerator used to store medicines has been purchased and is in use. Records are kept of the temperatures. All care staff currently involved in the administration of medication have had appropriate training or are appropriately supervised in their work.
St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 10 In respect of the recording of medication the home is now noting the actual dose that is administered when the dose of the medication varies. When the home returns medication for disposal, when it has not been used or needed, the quantity for disposal is now being noted which is necessary in order to complete the audit trail of medication handled by the home. The Inspector also saw that the home is recording when a new container is started, again important for audit trailing and to ensure that medication is used within specific periods after the date it is opened. A risk assessment has been undertaken for the resident who is self medicating. Medication Administration charts had not been completed for the morning of inspection although medications had been administered to residents. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (Standards 12, 13, 14 and 15 were met at the last inspection). None of these standards were assessed on this occasion. EVIDENCE: St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 (Standard 16 was met at the last inspection). The home’s adult protection policy demonstrates an understanding of abuse and of how residents are protected. EVIDENCE: As required at previous inspections the adult protection policy has now been reviewed (May 2005) and now includes information about the Protection of Vulnerable Adults list. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 25. (Standards 19,20,21,23,24 and 26 were met at the last inspection) Progress continues to be made to ensure the safety of residents at all times with the manager having a good understanding of what needs to be done. EVIDENCE: All rooms have emergency call bells in them for residents to summon help if they need it. Following the last inspection the manager checked all rooms to make sure that residents could reach the bells from wherever they usually lie or sit. This audit resulted in only one call bell lead having to lengthened. Some radiators in the home are guarded. Others identified as posing a potential risk to residents are yet to be covered. In the meantime furniture is being placed in front of them or other methods employed to minimise the risk of burns. An assessment of the whole premises has not yet been undertaken by suitably qualified persons as recommended in previous reports.
St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28 (Standards 29 and 30 were met at the last inspection). Sufficient staff are on duty at all times to meet the needs of the residents. Care staff would benefit from training to update their knowledge and make them better able to meet the needs of the residents. EVIDENCE: Staff are not issued with contracts. Staff rosters showed the number of staff on duty and what jobs they do. It was clearer from the rosters at this inspection who was in charge of the home when the manager was not on the premises, although the manager was not routinely noting when she was on duty. Rosters were not clear as to who was to be on duty or who had worked at the home. Recent staff changes at the home have meant that the home has had to call upon staff from the St Bridget Care Agency to cover shifts. These changes have contributed to the problems the manager has had in drawing up rosters. One member of staff out of 6 care staff employed at the home has a NVQ at level 2. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38 (Standards 31,36 and 37 were met at the last inspection). Whilst there is nothing to demonstrate that the home is not run in the best interest of residents a quality assurance system has not yet been fully implemented. The home is safeguarding the financial interests of residents. Records demonstrate that staff would know how to ensure the safety of resident in the event of a fire. However, the progress of meeting the recommendations made by the fire service in respect of the overall safety of the building is slow. EVIDENCE: A quality assurance system is in place and the suggestions box is still in use. Residents continue to express satisfaction with the home. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 16 Comment cards are yet to be made available to other stakeholders e.g. relatives and other visitors including health and social care professionals to gain their views about the home. Residents themselves or their relatives look after money for day-to-day expenditure. The Responsible person for the home receives some money for one resident that is passed on to the resident when it arrives and appropriate records are kept by the home. All records asked for at the inspection were made available. Fire training records confirmed that the home has a robust system for ensuring that staff are trained at appropriate intervals. The Proprietor is working with the Local Fire and Rescue service to progress the recommendations that they have made about improving fire safety at the home. The recommendations made by the Environmental Health Officer about the kitchen prior to the last inspection are yet to be addressed i.e. putting diffusers on the fluorescent strip lighting and creating a rack to store the chopping boards. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x 2 x x 2 x STAFFING Standard No Score 27 2 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 x x 2 St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 17 Requirement Medication charts must be signed at the time of administration so that there is evidence that residents’ medicines are given as prescribed. (Previous timescale of 20 May 2005 not met) 2 OP25 13 The programme of covering / 01/01/06 guarding or replacing with low temperature surfaces all radiators and pipework, assessed as posing a risk to residents, is to be completed. (Previous timescale of 1 August 2005 not met) 3 OP27 17 There must be a recorded staff rota showing which staff (including the manager) are on duty at any time during the day and night and in what capacity. There must also be a record of whether the roster was actually worked. 01/11/05 Timescale for action 14/10/05 St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 19 4 OP33 24 Comment cards must be made available to relatives, visitors and professionals to give feedback to the home as part of the quality assurance system. (Previous timescale of 1 August 2005 not met) 01/04/06 5 OP38 23 Adequate arrangements must be in place to comply with the recommendations of the Fire and Rescue Service. (Timescale of 31/12/04 not met and renegotiated). 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP22 OP27 OP28 OP38 Good Practice Recommendations It is recommended that an assessment of the premises is undertaken by an occupational therapist or another suitably qualified person. It is recommended that all staff employed at the home have contracts of employment. It is recommended that the home ensures that 50 of care staff attain NVQ level 2 by the end o 2005. It is recommended that the recommendations made by the Environmental Health Authority are carried out. St Bridget`s Residential Home DS0000003985.V259069.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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